Similar Psychopathological Profiles in Female and Male Cushing's Disease Patients after Treatment but Differences in the Pathogenesis of Symptoms

Abstract

Background: Female Cushing's disease (CD) patients with active disease present more frequently with depression compared to their male co-sufferers. This study investigated whether the gender difference prevails after remission and whether gender-specific factors contributing to mental health exist. Methods: 72biochemically cured CD patients (11 male, mean age 45.9 ± 13.7 years) who underwent transsphenoidal tumour removal filled out the Symptom Checklist-90-Revised inventory on average 42.1 ± 32.9 months after surgery. Multiple regression analyses included the following independent factors: (i) age, (ii) presence of comorbidities, (iii) presence of hypocortisolism, (iv) presence of hypopituitarism, (v) disease duration until diagnosis, (vi) time elapsed since surgery, and (vii) postoperative radiotherapy to predict postoperative psychopathology. Results: Regarding the Global Severity Index, 23.0% of the female and 27.3% of the male CD patients presented with abnormal scores. In all nine dimensions, psychopathological abnormalities were present in both female and male patients with the same frequency and intensity (each p > 0.05). Prolonged time to diagnosis was a strong predictive factor for worse psychopathological status only in male patients. Among female patients, only the presence of comorbidities and to some extent pituitary deficiencies were related to psychopathological status. Conclusions: During the remission phase of CD, female and male patients present with similar psychopathological profiles. In males, long-term biochemical effects of previous hypercortisolism seem to be salient for psychopathology. In contrast, in females, the presence of comorbidities/stressors they have to cope with is the predictive factor for psychopathology. The results underline gender differences in CD and the need to separate them on various issues.

Sex Differences in Presentation but Not in Outcome for ACTH-Dependent Cushing's Syndrome

“…One study reported more macroadenomas, with higher invasion and apoplexy rate (11), whereas another study reported equal percentages of macroadenomas in males and females (12). No differences were found in quality of life between males and females on multiple validated questionnaires (CushingQoL, EQ-VAS, and SCL-90-R) (8, 11, 17). Table 1 summarizes the reported literature regarding sex differences (also reported as gender differences) in Cushing's syndrome (8–18).…”